Indian Journal of Ophthalmology - Case Reports

CASE REPORT
Year
: 2022  |  Volume : 2  |  Issue : 2  |  Page : 395--396

Electron microscopic analysis of explanted opacified posterior chamber intraocular lens


Kandagadla Jyoti1, Maj Sumedha Vats2,  
1 Senior Consultant Ophthalmology and Anterior Segment Surgeon, Vasan Eye Care Hospital, Secunderabad, Telangana, India
2 Graded Specialist Ophthalmology, Army Hospital Research and Refferal, New Delhi, India

Correspondence Address:
Kandagadla Jyoti
Flat No. 203, GKs Sri Sai Residency, SV Officer's Colony, Secunderabad-56, Telangana, India. Work carried out at: INHS Kalyani, Vishakapatnam, Andhra Pradesh
India

Abstract

Opacification of intraocular lens rare phenomenon occurs and causes extreme diminution of vision in patients even after uneventful cataract surgery. Several reports of wrong diagnosis and delayed diagnosis of an opacified IOL leads to delayed treatment. The opacified IOL needs to be removed and exchanged with another PCIOL. This case report describes the electron microscopic analysis of an explanted intraocular lens and also gives details of the chemical composition. This is the first case report where presence of potassium has been noted in the opacified IOL as was detected by Scanning electron microscopic analysis.



How to cite this article:
Jyoti K, Vats MS. Electron microscopic analysis of explanted opacified posterior chamber intraocular lens.Indian J Ophthalmol Case Rep 2022;2:395-396


How to cite this URL:
Jyoti K, Vats MS. Electron microscopic analysis of explanted opacified posterior chamber intraocular lens. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 17 ];2:395-396
Available from: https://www.ijoreports.in/text.asp?2022/2/2/395/342976


Full Text



Opacification of intraocular lens (IOL) is a rare phenomenon; however, there are a few case reports of the same in the literature. In this case report, we have done the electron microscopic analysis of the explanted opacified IOL. Our case is unique because the electron microscopic analysis done by energy dispersive X-ray findings show deposition of calcium, potassium, and carbon. No other case report or study has found the presence of potassium. Electron microscopic image of the same has been taken and chemical analysis done.

 Case Report



A 45-year-old patient who had undergone uncomplicated cataract surgery 1 year back had presented with complaints of diminished vision RE. On slit-lamp examination, there was opacification of the posterior chamber IOL. His initial best-corrected vision was 6/60. There was no posterior capsular opacification and the entire posterior chamber IOL was opaque. The treatment plan was to explant the opacified IOL and replace it with another IOL. The patient was a known diabetic with increased blood sugar levels. After his blood sugar levels were controlled, the patient was taken up for IOL explantation and an exchange of IOL done. After the posterior chamber intraocular lens (PCIOL) exchange, the patient regained BCVA of 6/6. The explanted PCIOL [Figure 1] was then sent for electron microscopic analysis and the results are reproduced below [Figure 2] and [Figure 3]. Magnified electron microscopic view seen in [Figure 4].{Figure 1}{Figure 2}{Figure 3}{Figure 4}

 Discussion



Calcification of IOL is not a common phenomenon after cataract surgery. Our patient was a diabetic who had accelerated calcification over a few months post-operatively after cataract surgery. Scanning electron microscopy (SEM) analysis showed organic and inorganic material. Organic carbon crystals have been demonstrated. Xiangying et al. attributed the calcification to the viscoelastic material.[1] We had used the particular brand of viscoelastic not only on this patient but on other patients also who underwent cataract surgery and no other patient was found to have lens opacification. So, our case was unrelated to the viscoelastic substance used. According to their study, calcium bicarbonate and calcium phosphate were found.

Bhattacharjee et al.[2] conducted scanning electron microscopy (SEM) on opacified IOLs and suggested hydrolytic biodegradation in the hydrophobic IOL and demonstrated sodium and chloride spikes on electron microscopy. In our case, electron microscopy revealed calcium and potassium crystals in the IOL material.

Pandey et al.[3] reported bilateral calcification of IOL in a diabetic patient and sent the IOL for electron microscopy that showed calcium crystals like our case. In addition to calcium, the IOL revealed potassium crystals in our case.

 Conclusion



Opacification of intraocular lens is a rare phenomenon which causes dimunition of vision and requires the removal and exchange of IOL. This is the first case reported where on scanning electron microscopic analysis of explanted opacified PCIOL has shown the presence of Pottasium in addition to calcium which has been reported earlier.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Guan X, Tang R, Nancollas GH. The potential calcification of octacalcium phosphate on intraocular lens surfaces. J Biomed Mater Res A 2004;71:488-96.
2Bhattacharjee H, Buragohain S, JaveriHJ, Das D. Scanning electron microscopic features of explanted degraded hydrophobic acrylic intraocular lenses which were in vivo for a prolonged period. Indian J Ophthalmol 2020;68:1086-9.
3Pandey SK, Werner L, Apple DJ, Kaskaloglu M. Hydrophilic acrylic intraocular lens optic and haptics opacification in a diabetic patient: Bilateral case report and clinicopathologic correlation. Ophthalmology 2002;109:2042-51.